Zusammenfassung
Hintergrund
Seit nahezu 2 Jahrzehnten sind spektrale Computertomographie(CT)-Systeme im Einsatz in der klinischen Diagnostik. Trotz der Verfügbarkeit der 2‑Spektren-CT sind die Anwendungen i. Allg. und im Bereich der onkologischen Diagnostik noch limitiert. Die 2‑Spektren-CT hat bislang noch keinen Eingang in onkologische Leitlinien gefunden. Diese Übersichtsarbeit erörtert die zugrunde liegende CT-Technologie mit ihren Stärken und Schwächen und zeigt dann anhand einer selektiven Literaturrecherche Anwendungsmöglichkeiten der 2‑Spektren-CT in der onkologischen Diagnostik auf.
Ergebnisse
Bis vor Kurzem war die Spektral-CT gleichzusetzen mit der 2‑Spektren-CT (Dual-Energy-CT, DECT). Die CT-Systeme basieren darauf, dass unterschiedliche Röntgenspektren den Detektor erreichen, was beispielsweise durch den Einsatz unterschiedlicher Röhrenspannungen oder Vorfilter erreicht werden kann. Seit knapp 2 Jahren sind photonenzählende CT-Systeme verfügbar, die die spektrale Information direkt aus der Energie der eintreffenden Photonen extrahieren. Theoretisch lassen sich aus der spektralen CT durchaus Vorteile für die onkologische Diagnostik ableiten, sei es erhöhte Sensitivität/Spezifizität bestimmter Untersuchungen, Therapiemonitoring oder Prognoseabschätzung oder eine Dosisreduktion. Aufgrund der Vielfalt technischer Lösungen und aufgrund der vielen Freiheitsgrade bei der Bildrekonstruktion (monochromatische Bilder unterschiedlicher keV-Werte, Virtual-non-Contrast[VNC]-Bilder, Jodmaps usw.) mangelt es jedoch an Standardisierung und Vergleichbarkeit der Protokolle, Vorgehensweisen und an der Reproduzierbarkeit der Ergebnisse über verschiedene Scannertypen hinweg.
Abstract
Background
Spectral computed tomography (CT) systems have been in use in clinical diagnostics for nearly two decades. Despite the availability of dual-energy CT, application in general and in the field of oncology diagnostics is still limited. Dual-energy CT has not yet found its way into oncology guidelines. This review discusses the underlying CT technology with its strengths and weaknesses and then identifies potential applications of dual-energy CT in oncological diagnostics based on a selective literature review.
Results
Until recently, spectral CT was synonymous with dual-energy CT (DECT). CT systems are based on different X‑ray spectra reaching the detector, which can be achieved, for example, by using different tube voltages or prefilters. Photon-counting CT systems that extract spectral information directly from the energy of the incoming photons has been available for about 2 years. Theoretically, spectral CT can definitely be used to derive advantages for oncological diagnostics, be it increased sensitivity/specificity of certain examinations, therapy monitoring, prognosis estimation, or dose reduction. However, due to the variety of technical solutions and due to the many degrees of freedom in image reconstruction (e.g., monochromatic images of different keV values, virtual noncontrast [VNC] images, iodine maps), there is a lack of standardization and comparability of protocols, procedures, and reproducibility of results across different scanner types.
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Danksagung
Vielen Dank an Lukas Hennemann für die Unterstützung bei der Vorbereitung des Manuskripts.
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M. Lell und M. Kachelrieß geben an, dass kein Interessenkonflikt besteht.
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Lell, M., Kachelrieß, M. Spektrale Computertomographie in der onkologischen Diagnostik. Onkologie 29, 1060–1068 (2023). https://doi.org/10.1007/s00761-023-01415-9
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DOI: https://doi.org/10.1007/s00761-023-01415-9
Schlüsselwörter
- Diagnostische Bildgebung
- Sensitivität und Spezifizität
- Spirale Computertomographie
- Multidetektorcomputertomographie
- Metastasen
- Dual-energy CT